title: Peri-operative hyperglycemia is associated with delayed graft function in deceased donor renal transplantation.
abstract: Increasing evidence indicates that recipient diabetes is a risk factor for delayed graft function (DGF) after renal transplant and that peri-operative hyperglycemia increases ischemia-reperfusion injury. To evaluate whether peri-operative hyperglycemia as measured in the post-anesthesia care unit (PACU) after transplant is a risk factor for DGF, we retrospectively reviewed 976 adult recipients of deceased donor renal transplants between January 1, 1997 and December 1, 2004. Logistic regression was used to evaluate risk factors for DGF. In our final multivariate model, recipient blood glucose level in the PACU (odds ratio [OR] 1.10 per 25 unit increase, 95% confidence interval (CI) 1.14-2.46, p = 0.03) was a statistically significant predictor of DGF along with donor age (OR 1.02, 95% CI 1.01-1.03, p < 0.01), cold ischemia time (OR 1.04, 95% CI 1.02-1.07, p < 0.01), recipient male gender (OR 1.68, 95% CI 1.14-2.68, p = 0.01), and a panel-reactive antibody >30% (OR 1.92, 95% CI 1.20-3.05, p = 0.01). We conclude that recipient blood glucose measured in the PACU is associated with DGF and begs the question of whether improved peri-operative glucose control will decrease the incidence of DGF.
authors.affiliation: Division of Transplantation, Department of Surgery, University of California, San Francisco, CA 94143, USA. justin.parekh@ucsfmedctr.org
authors.forename: Justin
authors.initials: J
authors.lastname: Parekh
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Roll
authors.forename: Sandy
authors.initials: S
authors.lastname: Feng
authors.forename: Claus U
authors.initials: CU
authors.lastname: Niemann
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hirose
mesh_terms: D000328:Adult; D002102:Cadaver; D050377:Cold Ischemia; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D015427:Reperfusion Injury / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
keywords: delayed graft function; diabetes; hyperglycemia; kidney transplant